Questions and Answers
What conditions can amoxicillin treat?
Amoxicillin may rarely cause Clostridium difficile superinfection.
True
What should clients report if they experience it during treatment with penicillins?
Watery or bloody diarrhea
Match the antibiotic class to its therapeutic use:
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First-generation cephalosporins are effective against gram-negative bacteria.
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Which adverse drug reaction is a concern with tetracyclines?
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Cephalexin should be taken with _____ to decrease GI symptoms.
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What is a significant contraindication for using sulfonamides?
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Gentamicin can cause nephrotoxicity.
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What should be monitored during treatment with fluoroquinolones?
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Isoniazid is primarily used for the treatment of _____ tuberculosis.
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Rifampin can cause a red-orange color in body fluids.
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What should clients avoid while taking metronidazole?
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What serious side effect is associated with selective serotonin reuptake inhibitors?
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Patients should be monitored for _____ symptoms while on selective serotonin reuptake inhibitors.
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What is a therapeutic use of naloxone?
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Methylnaltrexone is used to treat opioid-induced constipation in late-stage cancer patients.
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What should be monitored in a patient receiving opioid analgesics?
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The opioid antagonist used to reverse opioid effects is called __________.
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What potential complication should be assessed with opioid use?
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Match the following opioid medications with their uses:
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Administering medications like opioids can lead to urinary retention.
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What should patients avoid when taking zolpidem?
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The therapeutic use of __________ is for chronic pain management.
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Which of the following is a contraindication for using metformin?
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Insulin should only be administered in a hospital setting.
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What is the action of fludrocortisone?
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Injection site reactions, such as ____________, can occur due to insulin.
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Which of the following are adverse drug reactions of Zolpidem?
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It is safe to abruptly discontinue opioid medications.
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Which of the following are contraindications for Lithium?
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What are the therapeutic uses of conventional antipsychotics like Chlorpromazine?
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Tardive dyskinesia occurs within the first few days of therapy with conventional antipsychotics.
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The lithium serum levels should be kept below _____ mEq/L.
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What should clients using amphetamines be instructed to avoid?
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Benzodiazepines can lead to tolerance and physical dependence.
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Which drugs are used as potential antidotes for benzodiazepine overdose?
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What is the primary therapeutic use of dopamine-replacement drugs like levodopa/carbidopa (Sinemet)?
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Which of the following conditions is a common contraindication for Valproates?
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Acetaminophen (Tylenol) is primarily used for _____ reduction.
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NSAIDs are safe to use during pregnancy without any concerns.
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Study Notes
Penicillins – Amoxicillin (Amoxil) and Amoxicillin/Clavulanic Acid (Augmentin)
- Treats broad-spectrum infections from gram-positive cocci and bacilli (e.g., ear, throat infections, UTIs).
- Amoxicillin is effective in non-penicillinase-producing gonorrhea.
- Clavulanic acid enhances amoxicillin's effectiveness and bacterial kill rate.
- Adverse reactions include GI symptoms (diarrhea, nausea, vomiting), risk of C. diff superinfection, Candida infections, and allergic reactions (rash, hives, wheezing).
- Monitor for GI symptoms and bloody stools; report any signs of infection.
- Avoid crushing extended-release forms; take at meals for better absorption.
- Contraindications include allergy to penicillin or hypersensitivity to procaine and benzathine.
First-Generation Cephalosporins – Cephalexin (Keflex)
- Effective against gram-positive cocci and urinary tract infections.
- Subsequent generations (2nd to 5th) target gram-negative bacteria, beta-lactamase, and CNS infections (e.g., meningitis).
- Adverse effects include GI symptoms (diarrhea, nausea), possible cross-allergy with penicillin, and rare risk of hemorrhage with cefotetan.
- Monitor for allergic reactions and gastrointestinal distress, especially bloody stools.
- Administer with food to mitigate GI symptoms; distinguish between similar generic names when prescribing.
Tetracyclines – Tetracycline, Doxycycline, Minocycline
- First-choice for chlamydia, mycoplasma, rickettsial infections, syphilis, and gram-positive infections.
- Can treat acne vulgaris through topical or oral forms.
- Adverse effects include GI disturbances, teeth discoloration in children and fetuses, hepatotoxicity, and photosensitivity.
- Monitoring includes liver function and symptoms of superinfection or skin reactions.
- Administer on an empty stomach; avoid before bedtime to prevent esophageal irritation; do not give to children under 8.
Aminoglycosides – Gentamicin
- Targets gram-negative aerobic bacilli and severe infections in combination with other antibiotics.
- Adverse effects include ototoxicity (tinnitus, vertigo), nephrotoxicity, and possible ataxia.
- Monitor blood levels and renal function; warn clients about signs of ototoxicity.
- Administer the drug IM deeply into a large muscle or IV with caution regarding dilution and rate.
Sulfonamides – Trimethoprim and Trimethoprim/Sulfamethoxazole (Bactrim, Septra)
- Treats UTIs, pneumocystis pneumonia, and acute cases of bronchitis.
- Adverse effects include GI issues, skin reactions, hematologic deficiencies, and severe rashes (Stevens-Johnson syndrome).
- Monitor for severe symptoms and encourage fluid intake.
- Administer with 8 oz of water; hydration is crucial to prevent crystalluria.
Urinary Tract Antiseptics – Nitrofurantoin (Macrodantin)
- Used for treating and preventing urinary tract infections.
- Adverse reactions include GI symptoms, respiratory signs, and peripheral neuropathy.
- Monitor for respiratory symptoms and kidney function; advise clients not to crush capsules.
- Administer with food or milk; check urine color changes.
Fluoroquinolones – Ciprofloxacin (Cipro)
- Broad-spectrum antibiotic for bacterial infections, particularly UTIs and anthrax prevention.
- Adverse effects include CNS symptoms, tendon rupture risk, and severe sun sensitivity.
- Monitor for GI symptoms and tendon pain; advise limiting sun exposure during treatment.
- Available orally and IV with specific infusion guidelines.
Antitubercular Agents – Isoniazid (INH), Pyrazinamide (PZA), Ethambutol
- Integral for treating active and latent tuberculosis.
- Can cause liver damage, peripheral neuropathy, CNS symptoms, and GI issues.
- Monitoring involves liver function and symptoms of neuropathy; administer pyridoxine as needed.
- Administer in combination with rifampin to prevent resistance.
Rifampin – Rifampin (Rifadin)
- Used as adjunct therapy for TB and effective against several infections (N. meningitidis, L. pneumophila).
- Adverse effects include liver toxicity and discoloration of body fluids.
- Monitor liver enzymes; administer with other TB medications to prevent resistance; take on an empty stomach.
Metronidazole
- IV form tackles anaerobic infections, while oral form treats various bacterial and protozoal infections.
- Adverse effects include GI symptoms, CNS disturbances, and harmless urine discoloration.
- Monitor for severe GI and CNS symptoms; administer on an empty stomach for optimal absorption.### Antifungal Medications (Azoles)
- Darkening of urine may occur; inform clients not to be alarmed.
- Common side effects: metallic taste, headache, dizziness.
- Alcohol should be avoided during treatment.
- Contraindications include active CNS diseases and pregnancy (teratogenic risk).
- Drugs: ketoconazole (topical) and itraconazole (oral) used for severe systemic fungal infections and cutaneous fungal infections.
- Adverse reactions for systemic use: liver toxicity, GI symptoms (nausea/vomiting, constipation/diarrhea), drowsiness, dizziness.
- For topical use: burning, itching, redness, localized hypersensitivity.
- Client monitoring: liver function tests, severe GI symptoms, CNS effects.
- Oral administration requires an acidic medium; best taken with cola.
Selective Serotonin Reuptake Inhibitors (SSRIs)
- Medications like fluoxetine (Prozac) treat major depression, bipolar disorder, panic disorder, OCD, premenstrual dysphoric disorder, and bulimia nervosa.
- Common side effects: insomnia, nervousness, sexual dysfunction, headache, weight gain, hyponatremia, and increased risk for suicidal ideation, especially in youth.
- Monitor for adverse reactions: insomnia, worsening depression, signs of hyponatremia, serotonin syndrome.
- Administer orally; can take 4-6 weeks for clinical effectiveness. Administer in the morning to avoid sleep disruption.
Lithium (Lithobid)
- Used to control acute manic episodes in bipolar disorder.
- Adverse reactions: GI issues, muscle weakness, drowsiness, confusion, polyuria, tremor, and toxicity risk.
- Therapeutic levels should remain below 1.0 mEq/L; symptoms of toxicity include nausea, ataxia, and seizures.
- Monitor weight, fluid intake/output, and thyroid function.
- Administer with food to prevent GI upset; take precautions for kidney function during treatment.
Conventional Antipsychotics (Chlorpromazine)
- Indicated for schizophrenia, acute manic episodes, nausea/vomiting, and intractable hiccups.
- Possible adverse effects: akathisia, Parkinson-like symptoms, tardive dyskinesia, anticholinergic effects, severe dysrhythmias, neuroleptic malignant syndrome.
- Treatment options include beta blockers for akathisia and anticholinergics for acute dystonia.
- Administer with food to minimize GI effects; monitor vital signs and cardiac health.
Amphetamines (Adderall)
- Treats ADHD in adults and children and narcolepsy.
- Common side effects include insomnia, nervousness, weight loss, hypertension, and potential for dependency.
- Monitor vital signs and weight; taper doses to prevent withdrawal.
- Administration should occur early in the day, with the last dose no later than 4 p.m.
Methylphenidate (Ritalin, Concerta, Daytrana)
- Indicated for ADHD and narcolepsy.
- Similar side effects to amphetamines, including insomnia and weight loss.
- Monitor for growth suppression in children; schedule "drug holidays" as needed.
- Administration varies by preparation; sustain-release forms shouldn't be crushed.
Benzodiazepines (Diazepam, Alprazolam)
- Used for anxiety, muscle spasms, seizure management, and acute alcohol withdrawal.
- Side effects: drowsiness, impaired recall, hypotension, and respiratory depression.
- Monitor for tolerance and dependence; taper withdrawal slowly.
- Administer orally or intravenously with care, especially for IV forms.
Dopamine-Replacement Drugs (Levodopa/Carbidopa)
- Relieve symptoms of Parkinson’s disease.
- Watch for nausea, darkening of urine, orthostatic hypotension, and possible dyskinetic movements.
- Monitor fluid intake and provide dietary advice to enhance drug absorption.
- Full therapeutic effect may take up to 6 months.
Hydantoins (Phenytoin)
- Effective for tonic-clonic seizures and partial seizures.
- Adverse reactions include CNS effects, gingival hyperplasia, and skin rashes.
- Monitor plasma levels (10-20 mcg/mL therapeutic range) due to narrow therapeutic range.
- Administer with meals to prevent GI upset and avoid sudden discontinuation.### Antiepileptic Drugs
Contraindications
- Teratogenic effects; should not be used during pregnancy.
- History of skin rash or severe adverse dermatological reactions.
- Bradycardia or heart block conditions.
- Prior allergic reaction to hydantoins.
- Seizures stemming from low blood sugar.
Traditional Antiepileptic Drugs - Carbamazepine (Tegretol)
Therapeutic Use
- Effective for partial and tonic-clonic seizures.
- Used as a mood stabilizer in bipolar disorder.
- Alleviates pain associated with trigeminal neuralgia.
Adverse Drug Reactions
- Visual disturbances, headaches, ataxia; CNS effects common.
- Possible reduction in blood cell production.
- Risk of serious skin rashes, epidermal necrolysis, and Stevens-Johnson syndrome.
- Photosensitivity may occur.
Interventions
- Initiate treatment with low doses of carbamazepine, adjusting gradually.
- Administer the majority of daily doses at night to limit daytime side effects.
- Monitor white blood cell and complete blood count; withhold treatment for low levels.
- Watch for skin rash and consider genetic testing for risk in Asian clients.
Administration
- Take with meals to reduce gastrointestinal disturbances.
- Sustained-release forms must be swallowed whole; chewable tablets can be crushed.
- Do not mix oral suspensions with other medicines.
Client Instructions
- CNS effects typically diminish over time; advise about decrease in alertness.
- Caution against driving if experiencing side effects affecting vision or coordination.
- Report signs of fever, sore throat, easy bruising, and rashes to a healthcare provider.
Valproates - Valproic Acid (Depakote)
Therapeutic Use
- Treats various types of seizures, including absence and myoclonic seizures.
- Manages mania in bipolar disorder.
- Prevents migraine headaches.
Adverse Drug Reactions
- Risk of bruising and prolonged bleeding due to decreased platelets.
- Gastrointestinal symptoms such as nausea and diarrhea.
- Can cause serious neural tube defects if used during pregnancy.
- Liver toxicity and potential pancreatitis must be monitored.
Interventions
- Regular monitoring of bleeding time and platelets; assess for bruising.
- Administer with food to minimize GI effects and use extended-release forms.
- Educate about the importance of taking folic acid for neural tube defect prevention.
Administration
- Available in oral and IV forms; enteric-coated forms are preferred.
- Instructions to dilute IV forms and avoid mixing with other medications.
Client Instructions
- Report any signs of bleeding or liver dysfunction, such as jaundice or stomach pain.
- Advisable to take with food and monitor overall health.
Centrally Acting Muscle Relaxants - Baclofen
Therapeutic Use
- Eases skeletal muscle spasms due to spinal injuries, multiple sclerosis, and cerebral palsy.
Adverse Drug Reactions
- Common early effects include drowsiness, dizziness, and gastrointestinal disturbances.
- Withdrawal symptoms may occur, including severe side effects from abrupt cessation.
Interventions
- Start dosing low and increase gradually to mitigate side effects.
- Administer with food to minimize GI upset.
Administration
- Available orally or via intrathecal infusion; do not stop abruptly.
Client Instructions
- Advise gradual position changes to prevent dizziness.
- Report any significant side effects, including muscle weakness.
Peripherally Acting Muscle Relaxants - Dantrolene
Therapeutic Use
- Relieves muscle spasms from strokes, spinal injuries, and multiple sclerosis.
- Treats and helps prevent malignant hyperthermia.
Adverse Drug Reactions
- Muscle weakness, a risk of respiratory depression, and liver toxicity.
Interventions
- Frequent assessments of muscle strength and monitoring of CNS effects required.
- Regular liver function tests should be conducted.
Administration
- Oral and IV formulations available; specific administration routes based on condition.
Client Instructions
- Notify clinicians of muscle weakness and avoid activities that require alertness if drowsy.
NSAIDs (COX-1 and COX-2 Inhibitors) - Aspirin and Ibuprofen
Therapeutic Use
- Reduces inflammation, alleviates mild to moderate pain, and lowers fever.
- Aspirin has antiplatelet properties.
Adverse Drug Reactions
- Possible GI upset, risk of ulcers, and kidney dysfunction.
- Aspirin linked with Reye’s syndrome in children.
Interventions
- Monitor for signs of gastrointestinal bleeding and treat H. pylori if necessary.
- For high-risk patients, proton pump inhibitors may be prescribed.
Administration
- Ensure proper dosage forms are taken appropriately, particularly enteric-coated types.
Client Instructions
- Recommended intake with food and in moderation to reduce gastric irritation.
- Report any unusual bleeding and changes in bowel habits.
Acetaminophen (Tylenol)
Therapeutic Use
- Primarily used for pain relief and fever reduction.
Adverse Drug Reactions
- Risk of liver damage in the case of overdose; hypertension linked to long-term usage.
Interventions
- Monitor for overdose symptoms; treatment includes acetylcysteine in emergencies.
Administration
- Do not exceed the recommended dosage; available in various formulations.
Client Instructions
- Encourage compliance with dosing guidelines and regular BP monitoring.
Opioid Therapy
Opioid Analgesics
- Primarily used for moderate to severe pain management; classified into agonists, agonist-antagonists, and antagonists.
Opioid Agonists
- Include drugs like morphine and fentanyl; used subcutaneously, orally, or via IV.
Adverse Drug Reactions
- Risks include respiratory depression, sedation, gastrointestinal issues, and the potential for dependency.
Interventions
- Regular monitoring of vital signs and bowel health; mitigating risks of respiratory depression is crucial.
Administration
- Needs careful dose management and administration routes based on patient condition.
Client Instructions
- Emphasis on cautious use and gradual position changes to avoid dizziness.
General Anesthesia/ Barbiturates - Methohexital Sodium
Therapeutic Use
- Rapid induction agent for anesthesia in short procedures.
Adverse Drug Reactions
- Possible significant respiratory and cardiovascular effects.
Interventions
- Mandatory monitor of respiratory and cardiovascular status during procedures.
Administration
- Strictly through IV; care must be taken to prevent tissue damage during administration.
Client Instructions
- Educate about the monitoring process during the procedure to alleviate concerns.
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Description
Learn about penicillins, specifically amoxicillin and amoxicillin/clavulanic acid, their therapeutic uses, and adverse drug reactions.
